Personalised Care Questionnaire

Helping us understand your unique needs to provide the care you deserve.

At U&I Care, we understand that care needs are deeply personal and vary from individual to individual.

To help us provide the best possible support, please take a moment to complete our personalised care questionnaire.

This information will allow us to tailor our services to your unique requirements, ensuring comfort, dignity, and independence in your own home.

I am enquiring on behalf of: eg myself, parents etc*

Tell Us About Your Needs:*

Other (please specify)*

Support Areas:

Please tick the areas where you or your loved one require assistance:

Other (please specify)*

Availability of Support:*

Are there any specific times when support is required? (e.g., mornings, evenings, weekends):

Medical Conditions or Specific Needs:*

Please provide details of any medical conditions, disabilities, or special requirements:

Mobility or Accessibility Needs:*

Yes

Do you require specialist equipment or adaptations (e.g., wheelchair access, hoists)?

If yes, please specify: *

Language and Cultural Needs:*

Do you have any specific cultural or linguistic preferences for your carer?

Activities and Interests:*

Are there hobbies or activities you would like support to continue?

Next Steps:

Once you submit this questionnaire, our team will review your responses and get in touch to discuss your care needs further. Together, we will create a bespoke care plan designed to support your independence and well-being.

This field should be left blank

Talk to us

You can trust us to provide the highest standard of live-in care, tailored to you or your loved one's individual needs.

Book a free assessment

Personalised Care Questionnaire

At U&I Care, we understand that care needs are deeply personal and vary from individual to individual.

Next Steps:

Talk to us

Leicester Address:

Walsall Address:

Information